Nurse Practitioners Boost Patient Satisfaction, Quality Outcomes

Having more nurse practitioners as part of inpatient staff can help improve patient satisfaction while cutting healthcare costs and adverse outcomes, according to new data from the University of Pennsylvania School of Nursing.

Particularly, hospitals that had inpatient nurse practitioner staff saw higher patient satisfaction scores, lower costs of care, and lower surgical mortality, the analysis found.

This data comes as the healthcare industry continues its debate about scope of practice laws, with many nurse practitioners arguing their profession should experience full practice authority. Those opposing full practice authority state that expanding such for nurse practitioners could threaten patient safety.

This analysis, conducted by the Center for Health Outcomes and Policy Research at U Penn Nursing, and the Hospital of the University of Pennsylvania gives credence to nurse practitioners’ arguments, said Linda Aiken, PhD, RN, the study’s lead author.

“This is the first large study to document the significant added value of hospitals employing nurse practitioners in acute inpatient hospital care as well as having good RN staffing,” Aiken, a professor of Penn’s Center for Health Outcomes and Policy Research and the Leonard Davis Institute of Health Economics, said in a statement.

“When we compared hospitals with the most and fewest NPs, we estimated that hospitals with more NPs had 21% fewer deaths after common surgical procedures and 5% lower Medicare costs per beneficiary.”

The research team looked at key clinical quality metrics, including mortality rates, cost of care, and patient satisfaction, for over 1.4 million patients receiving care at one of 579 hospitals across the country.

Patients receiving care with more nurse practitioners employed in an inpatient setting—defined as employing more than three nurses per 100 beds—tended to see better clinical quality outcomes, the researchers found. This included 30-day mortality, 7-day hospital readmissions, and shorter average length of stay, the researchers said.

This translated to lower healthcare costs, they added. Medicare spending per beneficiary (MSPB) dropped by 5.4 percent when hospitals has more than three NPs per 100 beds, the team found.

And meanwhile, more nurse practitioners meant higher patient satisfaction scores as measured by HCAHPs. Patients also reported better perceptions of clinical quality. Additionally, hospitals that employed more than three inpatient nurse practitioners per 100 beds saw lower nurse burnout and lower nurse staffing burnout.

The positive impacts prevailed after patient discharge, the report added. Nurses in hospitals with high nurse practitioner ratios said they were more confident that patients would be able to take care of themselves after discharge, potentially because having more skilled NPs on staff would improve patient education efforts.

“Our study shows that NPs in advanced clinical roles in inpatient care are a very valuable addition to excellent RN and physician care,” Regina Cunningham, PhD, RN, study co-author and chief executive officer of the Hospital of the University of Pennsylvania, stated publicly.  “This important study shows that nurse practitioners enhance hospitals’ success achieving clinical excellence, patient satisfaction, and lower per patient expenditures while also contributing positively to overall clinician wellbeing during challenging times.”

To be clear, this study assessed the impacts of having more nurse practitioners at their existing practice authority on staff; it did not measure clinical quality and patient satisfaction when nurse practitioners saw expanded practice authority.

Nevertheless, this study does corroborate many of the arguments nurse practitioners, including the American Association of Nurse Practitioners, issue in favor of expanded nurse practitioner practice authority.

“NPs have a more than 50-year proven track record of delivering high-quality, affordable, patient-centered care,” Sophia Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, AANP’s immediate past president, wrote in a November 2020 letters to the American Medical Association. “Patients receiving NP care have high satisfaction rates, shorter hospital stays, fewer avoidable emergency room visits and hospital readmissions and lower medication costs — not to mention significantly lower malpractice rates than their physician counterparts.”

NPs’ push for broader practice authority has been met with pushback from the AMA, which says care teams should indeed be multidisciplinary, but ultimately led by a physician. AMA also points out the extensive medical education physicians complete.